Andrew J. Kittelson

Future Directions in Painful Knee Osteoarthritis: Harnessing Complexity in a Heterogeneous Population

This perspective article proposes a conceptual model for the pain experience for individuals diagnosed with knee osteoarthritis (OA). Pain in knee OA is likely a heterogeneous, multifactorial phenomenon that involves not only the OA disease process but also elements specific to patient psychology and pain neurophysiology. The relevant contributions to the pain experience for any individual patient remain difficult, if not impossible, to definitively determine, and the rationale for many clinical treatment decisions arises primarily from a mechanistic understanding of OA pathophysiology. The Osteoarthritis Research Society International (OARSI) recently identified “phenotyping” of OA pain as a research priority to “better target pain therapies to individual patients.” This perspective article proposes that contributions from 3 domains—knee pathology, psychological distress, and pain neurophysiology—should be considered equally important in future efforts to understand pain phenotypes in knee OA. Ultimately, characterization of pain phenotypes may aid in the understanding of the pain experience and the development of interventions specific to pain for individual patients.

Determination of Pain Phenotypes in Knee Osteoarthritis: A Latent Class Analysis Using Data From the Osteoarthritis Initiative.

Knee osteoarthritis (OA) is a broadly applied diagnosis that may describe multiple subtypes of pain. The purpose of this study was to identify phenotypes of knee OA, using measures from the following pain‐related domains: 1) knee OA pathology, 2) psychological distress, and 3) altered pain neurophysiology.

Neuromuscular Electrical Stimulation Therapy to Restore Quadriceps Muscle Function in Patients After Orthopaedic Surgery: A Novel Structured Approach.

Neuromuscular electrical stimulation (NMES) involves the application of preprogrammed trains of stimuli to superficial skeletal muscles—by means of surface electrodes placed over the muscle belly—with the ultimate goal to evoke visible tetanic contractions. Unlike other electrical stimulation

Progressive multi-component home-based physical therapy for deconditioned older adults following acute hospitalization: a pilot randomized controlled trial

Objective: To determine whether a progressive multicomponent physical therapy intervention in the home setting can improve functional mobility for deconditioned older adults following acute hospitalization. Design: Randomized controlled trial. Setting: Patient homes in the Denver, CO, metropolitan area. Participants: A total of 22 homebound older adults age 65 and older (mean ± SD; 85.4 ±7.83); 12 were randomized to intervention group and 10 to the control group. Intervention: The progressive multicomponent intervention consisted of home-based progressive strength, mobility and activities of daily living training. The control group consisted of usual care rehabilitation. Measurements: A 4-meter walking speed, modified Physical Performance Test, Short Physical Performance Battery, 6-minute walk test. Results: At the 60-day time point, the progressive multicomponent intervention group had significantly greater improvements in walking speed (mean change: 0.36 m/s vs. 0.14 m/s, p = 0.04), modified physical performance test (mean change: 6.18 vs. 0.98, p = 0.02) and Short Physical Performance Battery scores (mean change: 2.94 vs. 0.38, p = 0.02) compared with the usual care group. The progressive multicomponent intervention group also had a trend towards significant improvement in the 6-minute walk test at 60 days (mean change: 119.65 m vs. 19.28 m; p = 0.07). No adverse events associated with intervention were recorded. Conclusions: The progressive multicomponent intervention improved patient functional mobility following acute hospitalization more than usual care. Results from this study support the safety and feasibility of conducting a larger randomized controlled trial of progressive multicomponent intervention in this population. A more definitive study would require 150 patients to verify these conclusions given the effect sizes observed.

Walking Speed in the Total Joint Arthroplasty Population

Total hip and total knee arthroplasties are common procedures, effective at improving self-reported function for patients with osteoarthritis. While self-report measures are commonly used to assess outcomes after total joint arthroplasty (TJA), they rarely accurately reflect the magnitude of physical performance deficits. Measures of walking speed allow for a simple and reproducible clinical assessment of physical performance after TJA, which may prove to be a useful clinical tool for tracking performance and establishing prognosis. Of the few studies examining walking speed after TJA, generally patients tend to improve after surgery, yet deficits of 17% to 20% persist when patients are compared with healthy controls.

Influence of Diabetes on the Recovery Trajectories of Function, Strength, and Self-Report Measures after Total Knee Arthroplasty

As the proportion of individuals with diabetes mellitus (DM) in the aging population and the number of total knee arthroplasties (TKAs) both continue to grow, understanding the outcomes for these patient populations is critical. The purpose of this study was to determine whether patients with and without DM differed in the recovery of 3 physical performance measures during the first 90 days following a TKA.

Assessing Radiographic Knee Osteoarthritis: An Online Training Tutorial for the Kellgren-Lawrence Grading Scale

Introduction Knee osteoarthritis (OA) is a degenerative form of arthritis commonly diagnosed in older adults. It presents clinically with patient complaints of pain and impaired function, which are thought to result from cartilage degeneration and other skeletal changes. These changes can by examined radiographically and quantified using the semiquantitative grading scale known as the Kellgren-Lawrence (KL) scale. Currently, no standard training exists for KL grading, which may explain the unsatisfactory reliability of this tool in OA research. Therefore, the objective of this project was to develop a training tutorial for KL grading of knee OA to educate assessors on possible areas of inconsistency in grading. Methods The tutorial was developed in an e-learning authoring tool, Articulate Presenter. The content focuses on the poor reliability of KL grading, normal anatomy of a knee radiograph, and multiple examples of bony changes within the knee and their relation to different grades of the KL scale. The tutorial was presented to a group of health sciences graduate students at the University of Colorado Denver. Results Students were able to complete the training and an associated assessment in under an hour and reported improved confidence with assessing radiographic knee OA. Furthermore, they demonstrated favorable inter- and intrarater reliability scores in applying KL grading. Discussion To our knowledge, this is the first attempt to standardize training in KL grading for knee OA and to examine the effects of this training on reliability.